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Project M delivers HIV/AIDS, TB care via mobile

National Geographic, Nokia Siemens Networks, frog design, the Praekelt Foundation, iTeach and African carrier MTN have partnered on a mobile social innovation program.

Pop!Tech, the annual ideas summit and social innovation network, in partnership with this coalition of world-class organizations, domain experts and cultural figures, has unveiled Project Masiluleke, or Project M, an effort that harnesses the power of mobile technology to help reverse the HIV/AIDS and tuberculosis crises in South Africa and beyond.

"In a country where the healthcare system is overburdened, mobile devices can be a profound tool for healthcare information, and that's what this is all about," said Andrew Zolli, curator and executive director of Pop!Tech, New York. "Using mobile devices, we can get people tested earlier and keep them in care longer as part of country-wide mobile initiative.

"This is the largest project for health care information delivered via mobile ever undertaken in history," he said. "We're treating mobile devices like media such as TV and radio, which is an important innovation, because this is a healthcare crisis unparalleled in human history."

The project embodies a vanguard new approach to these intractable public health challenges, tapping the mobile phone as a high-impact, low-cost means to deliver healthcare information and catalyze increased testing.

In the coming year, the initiative will reach millions in South Africa, a country of 48 million people, where 90 percent use mobile phones and AIDS kills 1,000 people every day.

The goal is to connect citizens nationwide to critical health-related information, as well as lifesaving HIV and TB resources.

Project M has also been designed to serve as a scalable, high-impact model that can be replicated worldwide.

"Many people who are HIV-positivel ook perfectly healthy, they're asymptomatic and only go to doctor when they're very sick," Mr. Zolli said. "People die waiting for treatment, but early testing would smooth out the demand curve on healthcare, make healthcare more efficient, and mobile is a tool to do this at scale.

"The goal is to mass mobilize people into treatment and to keep them there longer," he said. "Lots of young people use mobile phones and Please Call Me, and because we can send so many messages in a way that is very intimate and private, we're talking to the most at-risk demographics within the society, sexually active young people."

Project Masiluleke, which means "to give wise counsel" and "lend a helping hand" in Zulu, has brought together a world-class, interdisciplinary team of partners in design, mobile technology and healthcare.

Key contributors include global design and innovation firm frog design; South African pro-social mobile messaging group the Praekelt Foundation; groundbreaking South African HIV and TB outreach organization iTeach; Africa's leading cellular telecommunications company, MTN; global communications enabler Nokia Siemens Networks; one of the world's largest non-profit scientific and educational organizations, National Geographic; and a host of other partners.

Together, this collaborative team has invested several million dollars of in-kind value to establish the mobile phone as a bridge to treatment, bringing those with HIV and TB into the healthcare system much earlier and greatly increasing their chances of living a long, healthy life.

There are various key elements and stages of Project M.

Please Call Me x 1 million x 365
The first stage of the project is built around the use of specialized text messages, delivering approximately 1 million HIV/AIDS and TB messages each day for one year to the general public.

These messages are broadcast in the unused space of "Please Call Me," or PCM, text messages -- a special, free form of SMS widely used in South Africa and across the continent.

Using technology from the Praekelt Foundation, message content from iTeach, design insights from frog design and network capacity donated by MTN, the messages connect mobile users to existing HIV and TB call centers.

Trained operators provide callers with accurate healthcare information, counseling and referrals to local testing clinics.

After three weeks of beta testing, Project M has already helped triple average daily call volume to the National AIDS Helpline in Johannesburg.

Looking forward, assuming only 2 percent of PCM recipients respond in the coming year -- and only half of those initiate an HIV/AIDS test -- Project M has the potential to mobilize several hundred thousand South Africans to get tested in its first year alone.

Patients connected via TxtAlert
Only 10 percent of South Africans with AIDS are currently receiving anti-retroviral, or ARV, therapy, and of those who begin treatment, more than 40 percent do not remain on the life-saving drugs past two years.

Project M will address this critical problem through the Praekelt Foundation's TxtAlert technology, which uses text messaging to remind patients of scheduled clinic visits, helping to ensure they adhere to ARV regimens.

HIV+ virtual call centers
For Project M's second phase, plans are underway to implement virtual call centers, where existing help-lines will be augmented by teams of highly-trained, highly-adherent HIV+ patients.

These individuals will field questions remotely, via their mobile devices, from the general public.

Counselors will be closely vetted, trained and represent "gold-star" patients -- extremely knowledgeable about their illness, diligent about their treatment regimen and intimately familiar with the weight of an HIV+ diagnosis.

These virtual call centers hold the potential to create hundreds of new jobs and considerably increase the capacity of South Africa's health response system.

At-home HIV testing with mobile support
Ultimately, with more HIV+ citizens than any country in the world, and infection rates topping 40 percent in some provinces, South Africa demands a radical solution to truly reverse its HIV/AIDS and TB crises.

For the third phase of Project M, the project partners are actively exploring a breakthrough distributed diagnostics model: low cost, at-home HIV testing with mobile counseling support.

Analogous to a pregnancy test, these distributed diagnostics would provide a free, private and reliable way for anyone to take the critical first step of knowing his or her status, with high-quality information provided via mobile device.

Stigma is widely considered the number one impediment to increased HIV/AIDS and TB testing.

Many in South Africa are unwilling to take the risk of being seen standing in line at a clinic, waiting to be tested.

The country's healthcare system is also tremendously overburdened and incapable of providing care to the millions who need it.

A mobile-supported distributed testing service would address these impediments and help close the testing and care gaps, connecting home testers to knowledgeable counselors specially trained for this situation.

Home testing does raise some serious questions, which will require thoughtful analysis and careful planning.

However, an effective HIV home-testing service could help trigger system-wide positive change.

Early response from South African government and healthcare officials, as well as likely users in both urban and rural communities, has been overwhelmingly enthusiastic.

The Project M team hopes to initiate a global conversation about this and other potentially transformative solutions applicable in South Africa and worldwide.

frog design and iTeach are actively collaborating on design strategies which can guide a possible implementation of this solution.

Impressive partners
Project M is being incubated by the Pop!Tech Accelerator, which brings together world-class companies, foundations, NGOs, funders, artists and thought leaders to collaborate on outcomes none could achieve independently.

frog design is a leading global innovation firm with extensive experience developing breakthrough mobile applications and services on a global scale.

Committed to social development, frog is contributing service design expertise to ensure that all aspects of the user experience -- particularly the HIV home-test service -- are carefully crafted for maximum usability, value and relevance to the end user.

Its clients include Alltel, Disney, GE, HP, Logitech, Microsoft, MTV, Seagate and Yahoo.

The Praekelt Foundation is a South African-based non-profit committed to building innovative mobile technology solutions that improve the health and well-being of people living in poverty.

The Foundation is an incubator for new mobile-based solutions and developed the technology to insert the healthcare messages into existing PCMs, as well as the TxtAlert concept, two critical components of Project M.

Led by Krista Dong, MD and Zinhle Thabethe, iTeach is a leading HIV/TB education, outreach and service organization, headquartered at Edendale Hospital in KwaZulu-Natal, South Africa.

iTeach serves as the primary clinical site for Project M and the iTeach team has developed the content of all SMS messages, ensuring clinical, cultural and linguistic correctness.

A global enabler of communications services, Nokia Siemens Networks provides a well-balanced product portfolio of mobile and fixed network infrastructure services.

With operations in more than 150 countries, the company will play a key role in helping to propagate the Project Masiluleke model and teachings worldwide.

One of the largest and fastest-growing telecommunications companies in the developing world, MTN is donating up to 1 million "Please Call Me" messages per day for one year.

MTN South Africa is part of the MTN Group, a multinational telecommunications group operating in 21 countries in Africa, Asia and the Middle East.

The MTN Group claims more than 74 million subscribers across its operations in Afghanistan, Benin, Botswana, Cameroon, Cote d'Ivoire, Cyprus, Ghana, Guinea Bissau, Guinea Republic, Iran, Liberia, Nigeria, Republic of Congo (Congo Brazzaville), Rwanda, South Africa, Sudan, Swaziland, Syria, Uganda, Yemen and Zambia.

A leader in the South African music scene and among the most relevant cultural brands in the country, Ghetto Ruff and its artists have a long history of channeling their celebrity and voices to advance social change.

Three of the label's top young acts -- Jozi (Bongani Fassie, Leslie, Ishmael), Gumshev (Bruno and Fistos) and solo artist Malik -- have committed to help make Project M a success.

One of the world's largest non-profit scientific and educational organizations, the National Geographic Society is a supporter of the Pop!Tech Accelerator and Project M.

In addition to providing grant support, the National Geographic Society will be documenting the work of the project.

Understanding all too well the toll HIV/AIDS is having on South Africa and its prospects for the future, prominent members of the iconic Mandela and Sisulu families have signed on to support Project M.

Bhambathe Mandela, grandson of Nelson Mandela, and Moyikwa Sisulu, grandson of renowned African National Congress leader Walter Sisulu, are among those who have endorsed Project M and pledged to help drive adoption of the program.

Aricent is a full-service, full-spectrum communications software company committing technical assistance to Project M.

Aricent offers software services and products that enable the world's leading communications equipment manufacturers, device manufacturers and service providers to improve time-to-revenue and maximize efficiency.

South African initiative and Praekelt Foundation partner CellLife provides open-source services assisting with the management of HIV/AIDS using mobile technologies.

LifeLine Southern African collaborates with the South African National Department of Health to administer the country's National AIDS Helpline, a critical resource for those seeking more information about HIV/AIDS and TB testing and care.

The National AIDS Helpline is the pilot site for Project M, receiving inbound calls generated by PCMs.
Guiding the development of Project M are several of the most respected and decorated HIV/AIDS, TB and mobile health experts in the US and South Africa.

These include Dr. David Bangsberg of Harvard Medical School, Dr. Rocio Hurtado of Mass General, Dr. Patricia Mechaels of Columbia University and Dr. Francois Venter of the South African HIV Clinician's Society.

MTN subscribers send out 20-30 million Please Call Me messages per day.

About 1 million of those messages are Project M social impact message with a call to action designed to get people to contact a call center, text in to a short code or visit a WAP site to get more information or get tested.

MTN has a commitment for 12 months, and the coalition is actively planning for an extension.

"This technology was first tested and proven in a commercial context, which proved the power of incentives," said Gustav Praekelt, cofounder of the Praekelt Foundation, Johannesburg, South Africa. "There's a large demographic in Africa with disposable income who aren't being targeted with advertising, so we're targeting people using prepaid airtime on behalf of our client Unilever.

"Many people don't have access to TVs, yet when we ran these mobile campaigns, we got incredibly high response rates," he said. "We got 200,000 unique people that entered a Unilever campaign via SMS in a single month."